Party Lines and Other Mucosal Crimes: Nasal Septal Perforation: A Review of Common and Uncommon Causes

Neurographics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 182-195
Author(s):  
C.S. Taylor ◽  
T.A. Nichols ◽  
D.A. Joyner
Keyword(s):  
Differential Diagnosis ◽  
Nasal Septum ◽  
Clinical Symptoms ◽  
Septal Cartilage ◽  
Preoperative Imaging ◽  
Imaging Features ◽  
Septal Perforation ◽  
Ischemic Necrosis ◽  
Nasal Septal Perforation ◽  
Common Causes

Nasal septal perforation refers to the abnormal communication of the nasal cavities via a defect in the nasal septum. Clinical symptoms, if present, include bleeding, crusting, a sensation of nasal obstruction, and whistling noises during inhalation. The mucoperichondrium of the nasal cavity contains most of the nasal septal vasculature and sandwiches the relatively avascular septal cartilage. An insult to the mucoperichondrium on both sides of the septal cartilage in approximately the same area results in ischemic necrosis of the septal cartilage, which leads to nasal septal perforation. Nasal septal perforation is a common end to an expansive list of etiologies that occur due to ischemic necrosis or direct erosion of the osteocartilaginous nasal septum from a tumor or infection. Imaging alone is typically insufficient to establish the exact underlying etiology. However, there are imaging features that may narrow the differential diagnosis or suggest less common causes, particularly malignancy. Radiologists can also identify lesions that place the nasal septum at risk, such as for a nasal septal hematoma or an abscess. Preoperative imaging allows for the evaluation of the size of the defect, as well as other areas of osseous and cartilaginous destruction in the palate, sinus walls, or orbits, that may need surgical reconstruction.Learning Objective: Describe nasal septal anatomy, pathophysiology of nasal septal perforation, and the differential diagnosis for causes of nasal septal perforation.

Nasal septal carcinoma: initial symptom of nasal septal perforation

1988 ◽  
Vol 102 (9) ◽  
pp. 834-835 ◽  
Author(s):  
M. Echeverria-Zumarraga ◽  
C. Kaiser ◽  
C. Gavilan
Keyword(s):  
Squamous Cell Carcinoma ◽  
Differential Diagnosis ◽  
Nasal Septum ◽  
Early Stage ◽  
Surgical Excision ◽  
Young Female ◽  
Initial Symptom ◽  
Primary Squamous Cell Carcinoma ◽  
Septal Perforation ◽  
Nasal Septal Perforation

AbstractA case of a primary squamous cell carcinoma of the nasal septum in a young female with initial symptom of septal perforation is reported. Carcinoma of the nasal septum is an uncommon entity and there are a few cases reported in the literature. The functional impact of their treatment and the high mortality makes it important to diagnose it at early stage. We discuss the differential diagnosis of septal perforation and recommend early wide surgical excision.

scholarly journals Nasal Septal Perforation: Experience of Management

2021 ◽  
Vol 28 (3) ◽  
pp. 255-259
Author(s):  
Selçuk Kuzu ◽  
Çağlar Günebakan
Keyword(s):  
Nasal Septum ◽  
Inflammatory Diseases ◽  
Nasotracheal Intubation ◽  
Septal Perforation ◽  
Closure Rate ◽  
Composite Tissue ◽  
Nasal Septal Perforation ◽  
Common Causes ◽  
Septum Perforation ◽  
Nasal Septum Perforation

Introduction Nasal septal perforation is the loss of composite tissue comprising the mucosa, bone or cartilage structures that form the nasal septum. Nasal septum perforation has many causes. Though it may be idiopathic, the most common causes are iatrogenic like nasal surgeries. Among other reasons are septal hematoma, nasal picking habit, nasal cauterization due to nosebleeds, nasotracheal intubation, cocaine use, vasculitis, inflammatory diseases such as sarcoidosis, This study aims to review the approach to management of patients with nasal septal perforation who underwent repair of the perforation in a tertiary clinic, in the light of current literature. Materials and Methods In this study, the records of 27 patients who were diagnosed with nasal septal perforation and treated surgically in a tertiary clinic, between January 2015 and June 2019 were reviewed retrospectively. Results The successful closure rate of perforations was 74%. In 4 of 7 patients whose perforations were not completely closed, the perforation size was larger than 2 cm in diameter. Conclusion Successful repair of nasal septal perforation depends largely on the cause, location, size of the perforation, cartilage bone tissue on the perforation edges, surgical technique and the surgeon's experience.

scholarly journals Nasal Septal Perforation in Propylthiouracil-Induced Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Yusho Ishii ◽  
Tsuyoshi Shirai ◽  
Yousuke Hoshi ◽  
Yoko Fujita ◽  
Yuko Shirota ◽  
...  
Keyword(s):  
Nasal Septum ◽  
Rare Case ◽  
Inflammatory Cells ◽  
Graves Disease ◽  
Septal Perforation ◽  
Drug Induced ◽  
Nasal Septal Perforation ◽  
Anca Associated Vasculitis

Here, we present the case of a 29-year-old woman with nasal septal perforation and positive myeloperoxidase- (MPO-) anti-neutrophil cytoplasmic antibody (ANCA). She had been diagnosed with Graves’ disease and had been treated with propylthiouracil (PTU) for 14 months. A biopsy of the nasal septum revealed an infiltration of inflammatory cells, with no evidence of malignancy or granulomatous change. Because of the use of PTU, destructive nasal lesion, and positive MPO-ANCA, she was diagnosed with drug-induced ANCA-associated vasculitis (AAV) and was treated with prednisolone and methotrexate after the cessation of PTU. Although PTU is known to be the medicine that induces drug-induced AAV, the manifestation of nasal septal perforation in drug-induced AAV is poorly identified. This is the rare case of drug-induced AAV which manifested only nasal septal perforation.

scholarly journals Surgical management of intracranial capillary hemangiomas in children: report of 2 cases

2016 ◽  
Vol 17 (3) ◽  
pp. 310-317 ◽  
Author(s):  
Paul A. Grabb
Keyword(s):  
Differential Diagnosis ◽  
Surgical Management ◽  
Preoperative Planning ◽  
Clinical Presentation ◽  
Operative Management ◽  
Preoperative Imaging ◽  
Imaging Features ◽  
Pertinent Literature ◽  
Intraoperative Management

Two cases of intracranial capillary hemangiomas (ICHs) occurring in children are presented to highlight the surgical challenges encountered with these extremely rare lesions. The author describes their clinical presentation, preoperative imaging features, intraoperative findings, and operative management. The pertinent literature is reviewed. Recommendations for preoperative planning and intraoperative management are made based on the author’s experience and the literature for when ICH is considered in the differential diagnosis and encountered intraoperatively.

scholarly journals Systemic Lupus Erythematosus with Unusual Manifestations

2020 ◽  
Vol 17 (6) ◽  
pp. 43-53
Author(s):  
Lorena Manea ◽  
Cătălin Mihai Popescu ◽  
Raluca Popescu ◽  
Daniela Adriana Ion ◽  
Andreea Alexandra Nicola ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Nasal Septum ◽  
Disease Patient ◽  
Clinical Manifestations ◽  
Unknown Etiology ◽  
Septal Perforation ◽  
Systemic Lupus ◽  
Extended Defect ◽  
Nasal Septal Perforation

Abstract Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology, presenting with variable clinical picture. Having a high heterogeneity and lacking pathognomonic features, very often the diagnosis poses a great challenge for the clinician. Several unusual clinical manifestations such as nasal septal perforation and digital gangrene can occur in LES patients. Case report. We report the case of a 42-year-old woman, known with SLE, hospitalized in our department for a clinical presentation consisting of a recent major epistaxis, physical asthenia and acral necrosis of the upper limbs. Physical examination revealed an afebrile patient, with a cushingoid facies, facial telangiectasias, and necrotic scars localized on the distal phalanges, bilaterally. A diagnostic nasal endoscopy showed a large septal perforation with the absence of the cartilaginous nasal septum. CT highlighted an extended defect at the level of the cartilaginous part of the nasal septum. Conclusion. Nasal septal perforation remains an underdiagnosed invalidating complication of lupus and treated and discovered early could have an important impact on the general health of an already burdened by disease patient.

scholarly journals A case report of malignant primary pericardial mesothelioma with atypical imaging appearance: multimodality imaging with histopathological correlation

2020 ◽  
Vol 4 (2) ◽  
pp. 1-5
Author(s):  
Audra Banišauskaitė ◽  
Antanas Jankauskas ◽  
Valdas Šarauskas ◽  
Monika Aržanauskaitė
Keyword(s):  
Differential Diagnosis ◽  
Clinical Symptoms ◽  
Multimodality Imaging ◽  
Interventional Procedure ◽  
Histopathological Analysis ◽  
Imaging Features ◽  
Unsuccessful Attempt ◽  
Metastatic Calcification ◽  
Pericardial Mesothelioma ◽  
Extensive Calcification

Abstract Background  Primary pericardial mesothelioma is a rare primary cardiac malignancy, with three main histopathological types, sarcomatoid histotype being the rarest. The imaging features were atypical due to concomitant extensive calcification, which resulted in aggravated differential diagnosis. Case summary  A 45-year-old man presented to our hospital with non-specific clinical symptoms. According to clinical history, a mediastinal tumour had been suspected with a previous unsuccessful attempt of transthoracic computed tomography-guided biopsy at an overseas hospital with limited data of performed imaging procedures. Multimodality imaging at our centre revealed extensively calcified solid masses in the pericardium, invading the left atrium. As the imaging features suggested an atypical primary pericardial malignancy, a diagnostic thoracoscopy was performed. Histopathological analysis of specimen revealed sarcomatoid type of pericardial mesothelioma with areas of necrosis and foci of osteogenic differentiation. Despite planned treatment, 2 weeks after histological diagnosis, the patient passed away due to perforated peptic ulcer-related sepsis. Discussion  The presence of extensive calcification in the lesion resulted in a challenging imaging workup and diagnosis. Initial differential diagnosis included primary or metastatic calcification-prone tumour, secondary calcification due to haemorrhage after previous interventional procedure and other pathologies, such as tuberculous pericarditis, calcified amorphous tumour, among others. Calcification may be part of the histological tumour characteristics; however, proper history taking is crucial as concomitant diseases, previous treatment, and interventional procedures may alter the imaging pattern.

scholarly journals A false alarm of COVID-19 pneumonia in lung cancer with anti-PD-1 related pneumonitis: a case report and review of the literature

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ying Dai ◽  
Sha Liu ◽  
Yiruo Zhang ◽  
Xiaoqiu Li ◽  
Zhiyan Zhao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Differential Diagnosis ◽  
Clinical Symptoms ◽  
Close Contact ◽  
Ct Imaging ◽  
Imaging Features ◽  
Rt Pcr ◽  
Lung Lobe ◽  
Clinical Presentations ◽  
Novel Coronavirus

Abstract Background Pneumonitis belongs to the fatal toxicities of anti-PD-1/PD-L1 treatments. Its diagnosis is based on immunotherapeutic histories, clinical symptoms, and the computed tomography (CT) imaging. The radiological features were typically ground-glass opacities, similar to CT presentation of 2019 Novel Coronavirus (COVID-19) pneumonia. Thus, clinicians are cautious in differential diagnosis especially in COVID-19 epidemic areas. Case presentation Herein, we report a 67-year-old Han Chinese male patient presenting with dyspnea and normal body temperature on the 15th day of close contact with his son, who returned from Wuhan. He was diagnosed as advanced non-small cell lung cancer and developed pneumonitis post Sintilimab injection during COIVD-19 pandemic period. The chest CT indicated peripherally subpleural lattice opacities at the inferior right lung lobe and bilateral thoracic effusion. The swab samples were taken twice within 72 hours and real-time reverse-transcription polymerase-chain-reaction (RT-PCR) results were COVID-19 negative. The patient was thereafter treated with prednisolone and antibiotics for over 2 weeks. The suspicious lesion has almost absorbed according to CT imaging, consistent with prominently falling CRP level. The anti-PD-1 related pneumonitis mixed with bacterial infection was clinically diagnosed based on the laboratory and radiological evidences and good response to the prednisolone and antibiotics. Conclusion The anti-PD-1 related pneumonitis and COVID-19 pneumonia possess similar clinical presentations and CT imaging features. Therefore, differential diagnosis depends on the epidemiological and immunotherapy histories, RT-PCR tests. The response to glucocorticoid is still controversial but helpful for the diagnosis.

scholarly journals Nasal Septal Perforation Due to Desmopressin Nasal Spray Use

2021 ◽  
pp. 014556132110264
Author(s):  
Daniela A. Brake ◽  
Grant S. Hamilton ◽  
Stephen F. Bansberg
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Nasal Spray ◽  
Nasal Septum ◽  
Treatment Success ◽  
Septal Perforation ◽  
Spray Application ◽  
Nasal Septal Perforation ◽  
Clinical Considerations

Perforations of the nasal septum have many etiologies and occasionally result from intranasal medicated spray use. This case report describes a perforation related to the use of desmopressin nasal spray, which has not been previously reported in the literature. Clinical considerations presented in this article include appropriate technique of nasal spray application, appropriate monitoring of patients on intranasal sprays, and indications for evaluation by an otolaryngologist. Septal perforation treatment success is improved with an early diagnosis.

scholarly journals A paediatric patient with nasal septal perforation – symptoms, diagnosis and treatment options

New Medicine ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Maciej Pilch ◽  
Anna Tuszyńska ◽  
Karolina Raczkowska-Łabuda ◽  
Lidia Zawadzka-Głos
Keyword(s):  
Nasal Septum ◽  
Treatment Options ◽  
Diagnostic Methods ◽  
Septal Perforation ◽  
Nasal Cavities ◽  
Nasal Septal Perforation ◽  
Paediatric Patients ◽  
External Nose ◽  
Supporting Element ◽  
Medical University

Introduction. Nasal septum is an anatomical structure which not only separates both nasal cavities, but is also a supporting element for the external nose, and has an impact on its physiology. Structural abnormalities of the nasal septum, such as deviations and defects, affect the airflow in the nasal cavities. Nasal septal perforation is one of the factors that impair nasal patency due to secondary pathological changes. There are various treatment options, depending on the symptoms reported and the stage of septal lesions. Treatment strategy is selected individually for each patient. Aim. The aim of this paper was to discuss the symptoms, diagnostic methods and treatment options in children with nasal septal perforation. Patients of the Department of Paediatric Otolaryngology, Medical University of Warsaw, were included in the analysis. Material and methods. We present cases of 18 patients aged between 3 and 17 years, admitted to the Outpatient ENT Clinic at the Department of Paediatric Otolaryngology, Medical University of Warsaw. Results. A total of 18 patients aged between 3 and 17 years (mean age 12.83 years, SD = 4.34) reported to our clinic. In most cases, nasal septal perforation developed as a complication of septoplasty (4) or nasal trauma. Nasal bleeding and crusting were the most commonly reported symptoms. Perforation was accompanied by external nasal deformity in about 1/3 of patients. Conclusions. Only few reports on paediatric patients with nasal septal perforation may be found in literature. All data obtained was analysed based on reports describing adult and paediatric patients. The severity of symptoms varied depending on the aetiology.

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